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Updated: Jun 6, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Cholecystectomy in the presence of a large patent foramen ovale: laparoscopic or open?
Mark S Thoma1, John Maa, Nelson B Schiller
1Department of Anesthesia and Perioperative Care, the University of California, San Francisco, CA 94143-0648, USA.
Insights
Laparoscopic surgery is safe for obese patients with gallstones and a patent foramen ovale (PFO). The benefits of minimally invasive surgery outweigh the minimal risk of paradoxical emboli in these patients.
Area of Science:
- Cardiology
- Surgical Innovation
- Patient Safety
Background:
- Obesity and gallstones (cholelithiasis) often necessitate gallbladder removal (cholecystectomy).
- Laparoscopic cholecystectomy offers benefits but requires careful patient assessment.
- Patent Foramen Ovale (PFO) is a common cardiac anomaly with potential embolic risks.
Observation:
- A patient with obesity, cholelithiasis, and acute cholecystitis required emergency laparoscopic cholecystectomy.
- Preoperative imaging revealed a large patent foramen ovale (PFO) with a resting right-to-left shunt.
- The incidence of PFO in the general population ranges from 10% to 30%.
Findings:
- Surgeons determined that the advantages of laparoscopic surgery for this patient were significant.
- The risk of paradoxical emboli through the PFO during laparoscopy was deemed negligible.
- The benefits of minimally invasive surgery were prioritized over the minimal PFO-related risks.
Implications:
- Laparoscopic cholecystectomy can be safely performed in patients with PFO.
- This case supports the use of laparoscopic surgery despite the presence of PFO.
- Risk-benefit analysis is crucial for surgical decisions in patients with cardiac anomalies.
Abstract:
An obese patient with cholelithiasis and acute cholecystitis was scheduled for an emergency laparoscopic cholecystectomy. On preoperative workup, a 5-year-old echocardiogram showed a large patent foramen ovale (PFO) with a right-to-left shunt that was open at rest. Noting both the benefits of laparoscopic surgery and the substantial incidence of PFO in the general population (10% to 30%), the attending and consulting surgeons reasoned that the benefits of laparoscopy greatly exceeded an immeasurably small risk of paradoxical emboli.